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. 2013 Nov;166(5):887-94.
doi: 10.1016/j.ahj.2013.07.032. Epub 2013 Oct 4.

Frailty and risk for heart failure in older adults: the health, aging, and body composition study

Hassan Khan  1 , Andreas P Kalogeropoulos, Vasiliki V Georgiopoulou, Anne B Newman, Tamara B Harris, Nicolas Rodondi, Douglas C Bauer, Stephen B Kritchevsky, Javed Butler
Affiliations

Frailty and risk for heart failure in older adults: the health, aging, and body composition study

Hassan Khan et al. Am Heart J. 2013 Nov.

Abstract

Objective: The aim of this study was to assess the association between frailty and risk for heart failure (HF) in older adults.

Background: Frailty is common in the elderly and is associated with adverse health outcomes. Impact of frailty on HF risk is not known.

Methods: We assessed the association between frailty, using the Health ABC Short Physical Performance Battery (HABC Battery) and the Gill index, and incident HF in 2825 participants aged 70 to 79 years.

Results: Mean age of participants was 74 ± 3 years; 48% were men and 59% were white. During a median follow up of 11.4 (7.1-11.7) years, 466 participants developed HF. Compared to non-frail participants, moderate (HR 1.36, 95% CI 1.08-1.71) and severe frailty (HR 1.88, 95% CI 1.02-3.47) by Gill index was associated with a higher risk for HF. HABC Battery score was linearly associated with HF risk after adjusting for the Health ABC HF Model (HR 1.24, 95% CI 1.13-1.36 per SD decrease in score) and remained significant when controlled for death as a competing risk (HR 1.30; 95% CI 1.00-1.55). Results were comparable across age, sex, and race, and in sub-groups based on diabetes mellitus or cardiovascular disease at baseline. Addition of HABC Battery scores to the Health ABC HF Risk Model improved discrimination (change in C-index, 0.014; 95% CI 0.018-0.010) and appropriately reclassified 13.4% (net-reclassification-improvement 0.073, 95% CI 0.021-0.125; P = .006) of participants (8.3% who developed HF and 5.1% who did not).

Conclusions: Frailty is independently associated with risk of HF in older adults.

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Figures

Figure 1
Figure 1. HABC battery score and incident heart failure
Lower baseline HABC battery score was associated with a higher risk for heart failure. Rates are shown per 1000 person-years.
Figure 2
Figure 2. HABC battery score and heart failure risk
Hazard ratio and 95% “floating absolute” confidence intervals per quintile Health ABC battery are shown. The size of the box is proportional to the inverse of the variance of hazard ratio. Model adjusted for age and gender. Note: The fifth category is the reference
Figure 3
Figure 3. HABC battery scores and heart failure risk in subgroups
Frailty was associated with higher heart failure risk in multiple subgroups studied. Note: The model is adjusted for age and gender and stratified for prevalent coronary heart disease. CVD - Cardiovascular disease; LVH - left ventricular hypertrophy; T2D - type 2 diabetes mellitus
Figure 4
Figure 4. Comparison of discrimination of HABC battery scores and Gill index
See this image and copyright information in PMC

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